<?php $this->headScript()->appendFile($this->JS_PATH . 'request.js'); ?>
<?php $this->headScript()->appendFile($this->JS_PATH . 'bootstrap.datepicker.js'); ?>

<div id="request-listing"></div>
<div class="container-fluid">
<div id="pad-wrapper" class="form-page">
    <div class="row-fluid form-wrapper">
        <div class="span column span5">

            <?php if ($this->successmessage != ''): ?>
                <div class="alert alert-success">
                    <i class="icon-ok-sign"></i> <?php echo $this->successmessage; ?>
                </div>
            <?php endif; ?>
            <?php if (count($this->errorMessageArray) > 0): ?>
                <div class="alert alert-error">
                    <?php foreach ($this->errorMessageArray as $erroValue): ?>

                        <div class="text-left">
                            <i class="icon-remove-sign"></i>
                            <?php echo $erroValue; ?>
                        </div>
                    <?php endforeach; ?>
                </div>
            <?php endif; ?>
             <h3><?php echo $this->mode;?> <?php echo $this->translate("request_header"); ?></h3>
             <br/>
             <div class="request">
            <form role="form"  id="callout-form" name="callout-form"  enctype="multipart/form-data"  action="" method="post">
                <div class="field-box ">
                    <label><?php echo $this->translate("call_frm_name"); ?><span class="error-star">*</span>:</label>
                    <?php echo $this->form->call_person; ?>
                </div>


                <div class="field-box">
                    <label><?php echo $this->translate("call_frm_phone"); ?><span class="error-star">*</span>:</label>
                        <?php echo $this->form->call_contact_no; ?>
                </div>
                
                
                <div class="field-box">
                    <label><?php echo $this->translate("call_frm_comment"); ?><span class="error-star">*</span>:</label>
                        <?php echo $this->form->call_comment; ?>
                </div>
                
               
               
                
                <div class="field-box">
                    <label><?php echo $this->translate("call_frm_status"); ?><span class="error-star">*</span>:</label>
                    <div class="ui-select">
                    <?php echo $this->form->call_status; ?>
                    </div> 
                </div>
                <br>
                <div class="field-box">
                    <?php echo $this->form->Save; ?>
                    <?php echo $this->form->Reset; ?> 
                </div>
            </form>
             </div>
        </div>
        
     
    </div>
</div>
</div>    